Delivery models to improve adherence to medicines for chronic diseases in primary care

Global efforts to improve medication adherence have increasingly recognised that suboptimal control of chronic diseases is shaped not only by patient behaviour but also by the design and performance of health-care delivery systems. Although adherence is widely accepted as crucial to improved long-term outcomes, the structural role of medication-delivery models in supporting or constraining adherence remains underexplored. In this Health Policy, we provide an analysis of delivery systems of medicines for chronic diseases in 31 countries and aim to assess their regulatory designs, cost-efficiency, effects on access and adherence, and affordability to inform future dispensing policy. Across countries, medicines for chronic diseases are distributed through varied systems, including in-person pharmacy pick up and mail-order programmes. Innovations such as direct-to-consumer e-pharmacies, automated dispensers, and drone-based delivery have emerged from both large private-sector companies and adaptations in low-resource settings driven by necessity. However, many high-income systems have been slow to innovate, and these innovations experience challenges and barriers.